A Conversation with Patrick J. Medina, PharmD, BCOP

Patrick J. Medina, PharmD, BCOP, is Professor of Clinical and Administrative Sciences at the University of Oklahoma College of Pharmacy in Tulsa. At the 2017 Hematology/Oncology Pharmacy Association (HOPA) Annual Conference, Dr Medina, Editor-in-Chief of The Oncology Pharmacist (TOP), talked about changes to the reimbursement model, bridging the knowledge gap in a rapidly evolving field, and why provider status is the “Holy Grail” of pharmacy.

TOP: Why is achieving provider status for pharmacists so important?

Patrick Medina: Provider status has long been the holy grail of pharmacy. It was something that was talked about when I was in pharmacy school 20 years ago, but we are still quite a ways from where we need to be. California, North Carolina, and a couple of other states have progressive rules on provider status, and designate a pharmacist as a “clinical pharmacist practitioner” if they have achieved provider status. It is a special designation for pharmacists who can bill for reimbursement under Medicare Part B. The rest of the country, however, is still trying to get there.

Provider status is necessary for the profession to evolve. It is something that impacts my ability to hire new pharmacists, or expand current pharmacy services provided. It is something that every pharmacist, from every field of pharmacy, should be working to achieve.

TOP: Why has it taken so long to pass legislation?

Dr Medina: Certainly it is a complicated issue, but I think one of the main reasons is that the profession has been split for so long, and we have compartmentalized our issues. Whether it is a retail pharmacy, hospital pharmacy, oncology pharmacy, or any disease-specific pharmacy organization, pharmacy groups have worked independently to achieve provider status. Nurses are so powerful because they have one voice, and they worked together to get their provider status. In addition, physician assistants have achieved provider status before pharmacists, and it is a relatively new profession. However, pharmacists are finally starting to come together as one group with a more powerful message. By working together, we are hoping to push that legislation forward within a couple of years.

TOP: What are some emerging trends that oncology pharmacists need to be aware of?

Dr Medina: The transition of costs from a fee-for-service model to the Oncology Care Model is a huge shift that is happening. We are changing to a total cost of care model, in which providers will get paid a certain amount to treat a given patient with cancer. If a patient comes in with breast cancer, for example, the insurance company may allot $150,000 to treat that patient, so you are going to have to pick your drug therapy from a total cost of care standpoint, not just cost of the drug or service provided. Although efficacy will certainly trump everything, in the context of the total cost of care, cheaper drugs may be better. I think we will see drug prices start to lower, as high-cost drugs drive themselves out of the market.

Almost all new drugs are expensive, but the companies will have to be a little more cost-conscious in how they price certain drugs. They will no longer be able to charge whatever they want and have insurance companies pay that price. A good example of this is in the antiemetic category where there are several choices, ranging from $6 to $400. You can argue about the efficacy, but, assuming the more expensive drugs do not show huge therapeutic benefit, it is difficult not to use the cheaper drugs in that scenario. The more expensive drug would have to demonstrate improvements in emergency department visits and other costs of care to justify the cost. Decreasing the total cost of drug use from a pharmacy standpoint will be critical and include many other factors besides the cost of the drug.

TOP: How can oncology pharmacists help patients manage increasing costs?

Dr Medina: Out-of-pocket costs are increasing, and patients are being expected to pay more. Minimizing the financial impact on patients is a big issue in oncology in general, not just pharmacy, but a great role for pharmacists is in trying to help patients with copay assistance programs.

Patients receiving oral chemotherapy, for example, may have a 20% copay on a $10,000/month drug. Approximately 25% of new drugs are oral chemotherapy, so figuring out how to get them to our patients is a huge issue for oncology pharmacists.

TOP: How do oncology pharmacists keep pace with the rapid advancement of the field?

Dr Medina: I learn something new every year in oncology. We had ≥6 new drugs approved last year, and the year before we had >10. Knowledge of how to place these drugs in your treatment protocol as a pharmacist is constantly changing. Journals help, and organizations such as HOPA help us stay on top of that, as well.

Keeping informed of these developments is almost a necessity for oncology pharmacists because of cost. I want to help patients and understand the drugs, of course, but I also have to understand how it impacts my budget, my formulary, reimbursement, and patient assistance programs, etc.

TOP: What is the role of HOPA?

Dr Medina: HOPA is still fairly new—this is just the 13th year in which they have had an annual meeting—but there are now >1000 members. The goal of this organization is to bridge the knowledge gap for oncology pharmacists. HOPA also helps clarify practice agreements and reimbursement issues, and advocates for provider status legislation.

One of the other major initiatives of HOPA is working with nurses and physicians to educate them about the role of the oncology pharmacist with respect to other practice areas. It is the only organization that is solely dedicated to the profession; as such, it is the go-to place for oncology pharmacists.

TOP: What is the most rewarding part of your job?

Dr Medina: Helping patients. If you ask most oncology pharmacists, their number 1 goal is to help patients, although we get pulled into many areas, including financial management and education. It is rewarding when a patient comes back and says, “You helped me get through this side effect,” or “I understand this therapy a lot more because you talked to me.” I get a lot of personal satisfaction out of that.